There is no cure for osteoporsis. There are however several things that can be done to redress the loss of bone density and to minimise the risk of future fractures. As well as a range of pharmacological interventions it is generally agreed that everyone with osteoporosis will benefit from a good calcium intake and weight bearing exercise.
Non-pharmaceutical treatments
Exercise
The Scottish Intercollegiate Guidelines Network (SIGN) guidance on the management of osteoporosis states - "High intensity strength training and low impact weight bearing exercise are recommended as part of a management strategy for osteoporosis."
The guidance goes on to state that exercise should begin at a level at which patients feel comfortable and then increase in intensity and impact. Guidance produced by the Chartered Society of Physiotherapists states that for patients with advanced signs of osteoporosis-
Diet
Research suggests that a daily intake of 1000g of calcium leads to a 24% reduction in hip fractures. Drinking a pint of milk per day together with 2oz of hard cheese or sardines will provide the body with the required 1000g of calcium. The same amount can be obtained by taking calcium supplementation tablets. The SIGN guidance states that people over the age of 65 should take 10mcg daily of vitamin D and that people with vitamin D deficiency should take 20mcg daily. The Medicinenet site states-
"Vitamin D, along with adequate calcium (1200 mg of elemental calcium), has been shown in some studies to increase bone density and decrease fractures in older postmenopausal, but not in premenopausal or perimenopausal women."
Smoking
People who smoke should stop as smoking is known to accelerate the bone loss process. Smoking 20 cigaretees per day can result in an additional 5-10% loss in bone mass.
Alcohol
It is thought that excessive consumption (over 3 units per day) of alcohol increases bone thinning but that moderate consumption promotes bone density.
Pharmacological Treatment.
Biphosphonates
Biphosphonates reduce the risk of hip, spine and wrist fracture. The Medicinenet site states "To reduce side effects and to enhance absorption of the medicine, all bisphosphonates should be taken in the morning, on an empty stomach, thirty minutes before breakfast, and with at least 8 ounces (240 ml) of water (not juice). Taking the pill sitting or standing minimizes the chances of the pill being lodged in the oesophagus. Patients should also remain upright for at least 30 minutes after taking the pill to avoid reflux of the pill into the oesophagus."
Alendronate and risedronate are considered to be first line treatments for postmenopausal osteoporosis because they have both been shown to reduce hip and vertebral fractures. Alendronate is also approved for increasing bone density in men with osteoporosis.
Side effects of alendronate include- nausea, stomach pain, constipation, diarrhoea, bloating or feeling of fullness in the stomach, change in ability to taste food, bone, muscle or joint pain, headache, dizziness, flu-like symptoms.
Risedronate is less likely to cause oesophagus irritation and is more potent than alendronate in preventing bone thinning. Side effects may include nausea, dry mouth, stomach pain, diarrhoea, constipation, headache, dizziness, depression, anxiety, leg cramps, back pain, flu-like symptoms
Selective Estregen Receptor Modulators (Serms)
Raloxifene mimics the bone maintenance effects of oestregen and reduces spine fractures. It also reduces the risk of breast cancer without increasing the risk of heart disease. Raloxifene should be taken once daily, with or without meals. It is not yet known whether raloxifene has a beneficial effect on hip fractures. Side effects include hot flushes, sinusitis, weight gain and muscle pain.
Strontium Ranelate
Strontium ranelate reduces the risk of fracture in postmenopausal women with osteoporosis and is used for those who have an adverse reaction to alendronate and risedronate. Research published in the New England Journal of Medicine concluded that "treatment of postmenopausal osteoporosis with strontium ranelate leads to early and sustained reductions in the risk of vertebral fractures". Side effects can include diarrhoea and headache.
Parathyroid Hormone Peptides
Teriparatide and preotact are both given by means of a daily injection which patients are taught to administer themselves. Both are effective in reducing the risk of vertebral fracture but it is not yet known whether they have the same effect on the hips. These drugs are only given to people with severe osteoporosis who have not responded well to other forms of medication. Dizziness and leg cramps are the most common side-effects.
Calcitonin
Calcitinon is a naturally produced substance which helps the bones to stay healthy. It is given either by means of an injection or via a nasal spray. Injections are only normally given for the short-term treatment of painful vertebral fractures whereas the nasal spray can be used on a long term basis. Side effects include hot flushes, nausea, an unpleasant taste in the mouth and tingling hands. The nasal spray may also cause headaches and a blocked or runny nose.
